Steroid Injections for Spine Pain: What’s Rarely Discussed About the Risks

Today, I want to talk about something that often comes up during an office visit: epidural steroid injections, medial branch blocks, and intra-articular corticosteroid injections. Historically, these injections have been one of the most common treatments offered for back, neck, and joint pain. For many patients, they provide real, meaningful relief. They are a valuable tool and are still used by most orthopaedic practices.

But like any medical treatment, they are not without risks, and in my experience, those risks are often glossed over in a quick conversation before the procedure. My goal today isn’t to scare anyone away from a treatment that may genuinely help. It’s simply to walk through, in plain language, what the research tells us about the risks of the injection procedure itself, the risks of the steroid medication, and the situations where these injections may not be the right choice.

The Risks of the Injection Procedure Itself

Whenever a needle is placed near the spine or a joint, there is some inherent risk, even when the procedure is done carefully, under imaging guidance, by an experienced physician. The most common issues are minor: temporary soreness at the injection site, a brief flare-up of pain, light-headedness, or a small amount of bleeding or bruising.

Less common, but important to know about, are infection at the injection site or, rarely, within the spinal canal or joint itself; a dural puncture, which can cause a post-procedure headache; and nerve irritation, which usually causes temporary numbness, tingling, or weakness that resolves over days to weeks.

Serious complications such as significant bleeding around the spinal cord, spinal cord injury, stroke, or permanent neurological injury, are rare, but they have been reported in the medical literature, particularly with certain epidural injection techniques and approaches. This is part of why imaging guidance (fluoroscopy or ultrasound) and careful technique matter so much, and why these procedures should be performed by physicians with appropriate training.

The Risks of the Steroid Medication Itself

Separate from the procedure, the steroid medication that’s injected has its own set of effects on the body even though the dose is small and localized compared to oral steroids.

• Blood sugar changes: Steroids can cause a temporary rise in blood sugar, which is an important consideration for patients with diabetes.
• Bone density: Repeated steroid injections over time have been associated with a reduction in bone mineral density, which is a particular concern for patients who already have osteoporosis or osteopenia.
• Effects on cartilage: For intra-articular injections, research has suggested that repeated, higher-dose steroid injections into a joint may, over time, contribute to thinning of the joint cartilage. This is one of the reasons many physicians limit the frequency of these injections.
• Adrenal and hormonal effects: Even a localized steroid injection can be absorbed into the bloodstream in small amounts, and with repeated injections, this can occasionally affect the body’s natural hormone regulation.
• Mood and sleep changes: Some patients notice temporary changes in mood, sleep, or energy levels in the days following an injection.

For most patients receiving an occasional, well-spaced injection, these effects are mild and temporary. The concerns become more relevant when injections are repeated frequently over a short period of time.

Relative Contraindications; When Extra Caution Is Needed

“Contraindication” simply means a situation in which a treatment may carry additional risk and therefore requires extra discussion.  It doesn’t always mean the injection is off the table, but it does mean your doctor needs to weigh the risks and benefits carefully for your specific situation. Some of the more common relative contraindications include:

• Poorly controlled diabetes, given the potential for a temporary rise in blood sugar
• Active or recent infection, anywhere in the body, not just near the injection site
• Bleeding disorders or the use of blood thinners, which may need to be adjusted beforehand under physician guidance
• Significant osteoporosis, particularly when considering repeated injections
• Uncontrolled high blood pressure or heart failure, which can be affected by fluid retention from steroids
• Pregnancy, where the risks and benefits need individualized discussion
• A known allergy to any component of the injection, including the steroid, anesthetic, or contrast dye

A true absolute contraindication, meaning the injection should not be done, is uncommon, and includes things like active local or systemic infection, known bleeding disorders that haven’t been addressed, or known allergy to the medications being used.

The Bottom Line

Epidural steroid injections, medial branch blocks, and intra-articular corticosteroid injections remain valuable tools, and for many patients the benefits clearly outweigh the risks. But “common” doesn’t mean “risk-free,” and a good treatment plan starts with an honest conversation about both sides of that equation.

If you’re considering one of these injections, I’d encourage you to ask your doctor directly: How many injections have I already had, and is there a limit to how many more are advisable? Do I have any of the conditions above that might change the risk-benefit balance for me? What should I watch for afterward, and when should I call the office?

Please talk with your own physician before pursuing any injection-based treatment. This information is general in nature and isn’t a substitute for an individualized conversation about your health.

Until next time, this is Dr. Shim.

References

• Centers for Medicare & Medicaid Services. Local Coverage Determination (LCD): Epidural Steroid Injections for Pain Management (L39015).
• Epidural Corticosteroid Injections: Indications, Risks, and Contraindications. MedCentral.
• Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group. PMC, National Library of Medicine.
• Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain. The Clinical Journal of Pain, 2021.

Disclosure: This blog is intended for general educational purposes only and does not constitute medical advice. Always consult a qualified spine specialist before beginning or modifying any treatment, especially one involving injections or corticosteroid medications.

Last modified: June 12, 2026